Co-occurring Substance Use and Mental Health Needs: Enhancing the Adult Needs and Strengths Assessment (ANSA) to Manage Services

Substance use disorders (SUD) are common, affecting one in 25 adolescents (ages 12 -17), one in seven young adults (ages 18 to 25), and one in 16 adults (ages 26 and older) during 2017. 1 While 16.7% of adults without SUD experienced mental health (MH) disorders, 45.6% of adults with SUD experienced co-occurring MH disorders.1 Related research found much higher rates of adults with MH or SUD disorders (50-75%) have co-occurring disorders. 2, 3, 4, 5 Co-occurring MH and SUD make treatment more difficult, increase use of health resources, and interfere with individuals’ life functioning.2, 3, 4 In response to the opioid crisis, SUD treatment funding and services are expanding. Effective treatment requires identification of co-occurring disorders (COD). The goal of this study was to examine how well practitioners assess and identify COD in practice

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733−0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research

Integration of war-affected Arab refugees in the U.S.

This research explores factors affecting integration among war-affected Arab refugees in the U.S. Two indicators of refugee integration including local language proficiency and social connections are examined as outcome variables. This study finds education, health status, and the U.S. length of stay as significant factors predicting these outcomes

ANSA: Becoming a Recovery Focused Tool

poster abstractThe Adult Needs and Strength Assessment (ANSA, Lyons, 2009) has been used across public mental health and addiction services in Indiana to help develop intervention plans and to monitor client progress. ANSA consists of six core domains (Life Functioning, Behavioral Health Needs, Risk Behaviors, Strengths, Acculturation, and Caregiver). Domain items are rated on a four-point scale to describe the degree to which a need interferes with functioning or a useful strength is present. Despite statewide implementation, literature related to the ANSA is scarce. The study evaluates the psychometric properties of ANSA and its role as an outcome performance measure. Adults for whom the ANSA had been rated at four points between 2008 and 2010 were included (N=6320). Internal consistency reliability was measured for each ANSA domain and outcome measure. Reliable change indices (RCI) for each domain were used to calculate significant change. At each point of assessment and across time, the Cronbach’s alphas for all domains, except Risk Behaviors, are in the acceptable to high ranges (0.71 to 0.92), indicating good internal consistency and stability. For outcome performance measures, a more realistic timeframe for assessments (12 months) was required to document reliable improvement in at least one ANSA domain for individuals with serious mental health needs. The Residential Stability outcome measure has the low internal consistency and stability. From the recovery perspective, a new Community Integration measure was proposed as an alternative outcome measure and proved to be reliable (α = .90). Study findings helped enhance the ANSA tool, create a new outcome measure, and inform state policy. Specifically, bridging research to practice, findings resulted in restructuring the ANSA Risk Domain and modifying how outcomes are measured for adults in recovery focused behavioral health services

Civic Engagement among Middle Eastern and North African Refugees and Immigrants

This research explored the attitudes toward, frequency and predictors of civic engagement among the Middle East and North Africa (MENA) immigrants and refugees. Respondents (n=106) reported strongly positive attitudes and engaged in various civic activities. Attitudes were found as main predictor for level of civic engagement

Mental Health Service Access: Use of Existing Data

Background and Purpose. Although about 20% of children (ages 3 to 17) experience mental health disorders, only one in five youth receive specialized treatment. Without intervention, youth experience long lasting adverse effects. Barriers to service access include stigma, poverty, race/ethnicity, gender, and geography. Routine utilization of existing data could inform program and policy planning and monitor progress, but such information is seldom available. This study explored the use of administrative data to examine service utilization and to identify and address disparities in a midwestern state. Methods. Access to mental health (MH) services was defined as utilizing publically funded mental health. Two types of existing data were evaluated: mental health block grant (MHBG) and Medicaid claims. Uniform Reporting System (URS) Client Level Data for transition age youth (TAY, ages 18-20) 2004-2016 trends were compared by gender and race/ethnicity. Child Medicaid behavioral health service utilization in 2014 was contrasted by age, gender, race/ethnicity, and language. Relationships among language, identification of MH needs, and service utilization were also explored. Results. According to URS data, TAY youth’s utilization of MHBG funded services doubled then plateaued between 2013 and 2016. A pattern of more young women (55%) receiving services than men remained constant over time, although the 2015 census population estimates were similar. Disportionate access between white and non-white TAY decreased during a home and community based service grant (2008-2012). Based on SFY14 Medicaid claims, MH needs were most frequently identified for 12-14 year old boys, but service intensity peaked for adolescents between ages 15 and 17. In contrast to MHBG data, more young men, ages 18-25, utilized MH services. After age 25, women more frequently utilized services. However, boys and men consistently received more MH services. MH service utilization by youth of color was lower than by Caucasian youth. A limitation of using administrative date emerged as language was missing for foster youth who had the highest level of Medicaid MH service utilization. Most young Medicaid members (90%) lived in English speaking households; other households primarily spoke Spanish (5%), Burmese, or other languages. Children in English speaking homes received more than twice the amount services compared to children in Spanish speaking homes. MH health needs for children were less often identified in the four largest urban counties than in smaller communities. In contrast to research, the intensity of MH services varied across urban and rural settings. Conclusions and Implications. Consistent with research, this examination of administrative data found disproportionate identification of behavioral health needs and utilization of services by age, gender, race and ethnicity. Routine monitoring of existing data could help monitor MH service utilization and the impact of policy or programs on access to care. Gender differences between MHBG and Medicaid MH service utilization require further exploration. Additional research is needed regarding factors affecting geographic differences and the effectiveness of routinely using existing data to manage programs and inform policy.Indiana Family & Social Services Administration, Division of Mental Health & Addictio

Interprofessional Collaborative Attitudes: Comparing Social Work Learners to Their Medicine and Nursing Peers

Interprofessional learning activities in higher education aim to unite healthcare professionals in their future practice, thus reducing duplication and fragmentation of services. This study uses a social learning perspective to examine advanced practice medicine, nursing, and social work learners’ attitudes toward interprofessional education and collaborative practice activities within their university programs. The authors used a cross-sectional design to administer a questionnaire that included the Interprofessional Attitudes Scale (IPAS) to 151 advanced practice health care learners (internal medicine residents, nurse practitioner students, master’s-level social work students). Findings indicated significant differences in three subsections of the IPAS. Social work learners possessed a more favorable attitude than their medicine and nursing peers on teamwork, roles, responsibilities, and community-centeredness. Social work and nurse practitioner students indicated higher interprofessional bias issues than medical residents. The participants’ age was also found to be significant in the study. Further exploration will afford a more substantial knowledge base to address the fragmented, siloed, and service duplication that works against a more comprehensive and efficient healthcare system

Recovery from Severe Mental Illness – Pilot Research Paving the Way

poster abstractThe ACT Center of Indiana is a research and training center devoted to helping organizations provide services to adults with severe mental illness that are based on the best research evidence and promote recovery. We briefly highlight 5 recent pilot studies that ultimately may help improve care. These involve measuring factors that promote recovery (pilot #1), strategies to involving family members in recovery (pilot #2), ensuring active participation of consumers (pilot#3), reducing burnout in staff (pilot #4), and cost-effective ways to measure program implementation (pilot #5)

“We Have a Lot of Sleeping Parents”: Comparing Inner-City and Suburban High School Teachers’ Experiences with Parent Involvement

Teachers’ experiences with parent involvement were compared at an inner-city high school and a suburban high school. Parent involvement has been described as underutilized by teachers, due to either ideological barriers or cultural biases against parents of lower socio-economic status. A sample of 62 teachers found no significant group differences between teachers at the two schools for either problematic or collaborative parent involvement. There was a significant difference for beliefs about parent competency. Results may suggest that the ideological barrier of a “protective model” for home/school relations devalues parent involvement for teachers. Parent involvement may be further devalued for inner-city teachers, who hold beliefs that parent competence is reduced by socioeconomic challenges